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September 2013
Medicare Advantage Risk Adjustment Model adding HCC for morbid obesity
Documenting BMI
The degree of obesity and the BMI should be documented to indicate morbid obesity for adults 20 and older. The BMI categories, with their ICD-9-CM codes in parentheses, are:
- Normal BMI, 19 to 24
- Overweight (278.02), BMI 25 to 29.9 (V85.21 to V85.25)
- Obese (278.00), BMI 30 to 39.9 (V85.30 to V85.39)
- Morbid obesity (278.01), BMI 40 to 49.9 (V85.41 to V85.42)
- Super morbidly obese (278.01), BMI 50-plus (V85.43 to V85.45)
Morbid obesity has been assigned its own Hierarchical Condition Categories code as part of the changes to the Medicare Advantage Risk Adjustment Model. These changes will take effect with 2013 dates of service and the 2014 payment year.
“Morbid obesity has become such a prevalent problem in our country that the Centers for Medicare & Medicaid Services has this year elevated morbid obesity to be its own HCC in the Medicare Advantage Risk Adjustment Model,” said Thomas Ruane, M.D., medical director, Federal Business Division, Blue Cross Blue Shield of Michigan.
Proper coding and documentation for morbid obesity will ensure an accurate member risk score and appropriate reimbursement. It will also help guarantee that patients receive the best and most affordable care possible.
Dr. Ruane pointed out that simply documenting the patient’s weight isn’t enough information for complete specificity.
When documenting morbid obesity in a patient’s medical records, it’s important to note his or her body mass index and weight. If a physician documents a patient’s BMI but doesn’t state that the obesity is severe or morbid, then the condition can’t be reported to the Centers for Medicare & Medicaid Services.
Adult BMI is a Healthcare Effectiveness Data and Information Set measure, making it an important indicator in effectively treating patients for obesity.
Once a patient has been diagnosed as morbidly obese, a complete treatment plan should be recommended. The plan may include the following:
- Dietary consult
- Describing how the condition impacts the patient’s health
- Recommendation of exercise
- Weight loss medication
- Physician and patient discussions about concerns
- Monitoring patients’ weight gain or loss
- Bariatric consultation
- A diet consisting of 1,800 calories per day
For more information on the morbidly obese HCC, visit hccublog.scanhealthplan.com/2013/04/risk-adjustment-changes-for-2014.html.**
**Blue Cross Blue Shield of Michigan doesn’t control this website or endorse its general content. | 